Dr Muiris Houston: We need to acknowledge ‘mid Covid’. Many are suffering in silence

It’s time we focus on the considerable number who suffer symptoms directly after acute illness

A major study published in The Lancet a few days ago has, for the first time, put a definitive figure on the number of people affected by long term symptoms of Covid-19. One in eight adults (12.7 per cent) who are infected with Sars-CoV-2 go on to develop long Covid according to the study of more than 76,000 people.

Researchers from the University of Groningen in the Netherlands included people who hadn’t been infected with Covid-19 thereby allowing a comparison of symptoms in individuals both pre- and post-Covid-19 infection. The study structure also enabled a more accurate prediction of long-term Covid-19 symptom prevalence.

Prof Judith Rosmalen and her colleagues found that several symptoms were new or more severe three to five months after developing Covid-19, compared with symptoms before a Covid-19 diagnosis and to the control group, suggesting these symptoms can be viewed as the core symptoms of long Covid. The core symptoms recorded were: chest pain, difficulty or pain breathing, painful muscles, loss of taste and/or smell, tingling hands or feet, a “lump” in the throat, alternately feeling hot and cold, having heavy arms and/or legs and general tiredness. Notably, the severity of these symptoms plateaued at three months after infection with no further decline. And the authors were able to identify other symptoms that did not significantly increase three to five months after a Covid-19 diagnosis. These included headache, itchy eyes, dizziness, back pain and nausea.

One of the challenges with long Covid is the failure, thus far, to define an accurate time frame for the condition. It varies from four weeks to more than six months after a Covid-19 diagnosis, with three months being the most commonly used. In this study, long Covid symptoms were measured during a 90-150 day window after the acute phase of the illness.


Acute Covid, on the other hand, is more tightly defined: the European Centre for Disease Prevention and Control, for example, says “adults with mild to moderate Covid-19 (both Delta and Omicron) remain infectious no longer than 10 days after symptoms begin”. While some people recover within days, a two-week period seems a reasonable time frame with which to define the acute phase of the illness.

Which leaves a window of two weeks to 10 weeks post infection with Sars-CoV-2 with little or no medical focus. And it’s a group of people I am concerned about.

My antennae have been raised by anecdote rather than any formal research I have come across. Nevertheless, I think it’s time we labelled symptoms from this time frame as ‘mid Covid’ and it’s past time we focused on the considerable number of people who continue to suffer symptoms during this period.

So what are the stories of “mid Covid” I have seen and heard?

These people have symptoms from the acute period that continue to wax and wane, but are never completely resolved. Cough that is marked one day, but less bothersome the next. Breathlessness that comes and goes. Several people have described a strange “mobile pain” — one that affects different groups of muscles intermittently throughout the week. Single joints too become inflamed and painful for a day, with the person waking up after a night’s sleep to find the joint has settled. And taste figures highly in “mid Covid” symptoms — for some people even the strongest curries are rendered completely tasteless.

There are many reasons we need to focus on mid Covid: what is its prevalence; is it a factor in the development of long Covid; who in the population is prone to developing the condition; and can it be treated?

But most of all we need to acknowledge the existence of “mid Covid” to the many people in Ireland who may be suffering in silence.